Project CONNECTS (Communication and Outcomes that eNhaNce Equity in Childhood Tonsillectomy and Sleep)

项目 CONNECTS（增强儿童扁桃体切除术和睡眠公平性的沟通和成果）

基本信息

批准号：
10565822
负责人：
Emily Frances Boss
金额：
$ 60.67万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-01-05 至 2027-12-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10565822
关键词：
Address Adenoidectomy Affect Attitude Audiotape Behavior Black race Caring Child Child Care Child Rearing Childhood Clinical Code Collaborations Communication Communication Research Complex Consultations Coupled Decision Making Disparate Disparity Educational Intervention Elements Emotional Emotions Environmental Risk Factor Equity Ethnic Origin Family Goals Hispanic Institution Intervention Interview Language Learning Low income Maps Mediating Mediator Minority Operative Surgical Procedures Outcome Parents Participant Patient-Focused Outcomes Patients Perception Persons Play Population Postoperative Period Prevalence Procedures Published Comment Quality of Care Race Reaction Recording of previous events Reduce health disparities Regrets Reporting Research Role Sleep Sleep Apnea Syndromes Sleep disturbances Snoring Sum Surgeon Surgical complication Testing Time Tonsillectomy Trust Visit Vulnerable Populations Work alternative treatment care delivery care outcomes clinical encounter cohort communication behavior cultural competence disparity reduction ethnic bias ethnic diversity ethnic minority population experience health care quality implicit bias improved improved outcome innovation insight minority children patient oriented physical conditioning poor sleep preference racial bias racial diversity racial minority population recruit repository response shared decision making social surgery outcome therapy development

项目摘要

PROJECT SUMMARY/ABSTRACT We evaluate the influence of patient race/ethnicity and surgeon bias on communication and outcomes for children with obstructive sleep-disordered breathing (OSDB). OSDB occurs in up to 20% of children and impacts physical health, behavior, and learning. The primary treatment is tonsillectomy, with or without adenoidectomy, which is the most common major surgical procedure performed in U.S. children. Children who are Black or Hispanic have increased prevalence of OSDB, poorer sleep outcomes, and more complications of surgery. Clinician implicit bias may be an important contributor to these disparities, as evolving evidence shows that bias negatively impacts patient relationships, care delivery, and outcomes for vulnerable populations. We have previously shown that surgeons inconsistently offer alternatives to surgery and rarely elicit family preferences when speaking to parents, and that they are less likely to explore emotions of minority families. These findings, coupled with known disparities in OSDB clinical outcomes, highlight the critical problem that surgeon implicit attitudes toward minority families may influence communication, decision-making, and ultimately outcomes for children with OSDB. Our long-term goal is to improve equity, healthcare quality, and outcomes for children with OSDB. The overall objective of this application is to develop a comprehensive profile of the complex social and interpersonal dynamics that may affect treatment decisions and cause disparate patient outcomes for minority children. To do so, we will establish across three institutions a repository of audio-recorded encounters between a large, diverse cohort of surgical clinicians and parents of children undergoing OSDB consultations. We will first evaluate the influence of clinician implicit bias and patient race/ethnicity on surgeon parent-communication and quality and equity of OSDB care. We will quantitatively code communication behaviors (patient-centeredness, emotional responsiveness, and shared decision-making) of parents and clinicians occurring during child OSDB consultations and test for differences between high and low implicit bias clinicians, by patient race and ethnicity. We will also examine differences in parent trust in clinician, decision regret, and clinical outcomes, and assess whether communication behaviors mediate observed disparities in these patients and parent reported OSDB outcomes. We will then interview a subset of Black, Hispanic, and White parents and high and low bias clinicians to understand the potential influence of race, ethnicity, and bias on communication, and learn patient-centered solutions to improve communication. Using a stimulated recall qualitative approach, participants listen to audiotapes of their own clinical encounters and directly comment on salient elements of communication that occurred. Findings from this research will directly inform development of interventions to mitigate surgeon bias, promote culturally competent communication, and improve outcomes for children with OSDB.

项目概要/摘要我们评估患者种族/民族和外科医生偏见对沟通和结果的影响患有阻塞性睡眠呼吸障碍（OSDB）的儿童。 OSDB 发生在高达 20% 的儿童中影响身体健康、行为和学习。主要治疗方法是扁桃体切除术，伴或不伴腺样体切除术，这是美国儿童中最常见的主要外科手术。孩子们黑人或西班牙裔的 OSDB 患病率更高、睡眠结果更差等手术并发症。临床医生的隐性偏见可能是造成这些差异的一个重要因素，因为不断发展的证据表明，偏见会对患者关系、护理服务和治疗结果产生负面影响弱势群体。我们之前已经表明，外科医生提供的手术替代方案不一致在与父母交谈时很少引起家庭偏好，并且他们不太可能探索情感的少数民族家庭。这些发现，加上 OSDB 临床结果的已知差异，凸显了关键问题是外科医生对少数族裔家庭的隐含态度可能会影响沟通， OSDB 儿童的决策和最终结果。我们的长期目标是提高公平性， OSDB 儿童的医疗保健质量和结果。该应用程序的总体目标是开发可能影响治疗决策的复杂社会和人际动态的全面概况并导致少数民族儿童的不同患者结果。为此，我们将建立三个机构大量不同的外科临床医生和家长之间的录音相遇的存储库接受 OSDB 咨询的儿童。我们将首先评估临床医生隐性偏见的影响患者种族/民族对外科医生家长沟通以及 OSDB 护理质量和公平性的影响。我们将定量编码沟通行为（以患者为中心、情绪反应和共享儿童 OSDB 咨询和差异测试期间发生的父母和临床医生的决策）按患者种族和民族划分的高隐性偏见和低隐性偏见临床医生之间的差异。我们还将检查差异父母对临床医生的信任、决定后悔和临床结果，并评估沟通是否有效行为介导了这些患者和家长报告的 OSDB 结果中观察到的差异。我们随后将采访一部分黑人、西班牙裔和白人父母以及高偏见和低偏见的临床医生，以了解种族、民族和偏见对沟通的潜在影响，并学习以患者为中心的解决方案改善沟通。使用刺激回忆定性方法，参与者聆听以下内容的录音带：他们自己的临床经历并直接评论所发生的沟通的显着要素。这项研究的结果将直接为干预措施的制定提供信息，以减轻外科医生的偏见，促进具有文化能力的沟通，并改善 OSDB 儿童的治疗结果。